When talking about how doctors cope with the loss of their patients, Myron Cohen points to a set of Russian nesting dolls he keeps on his desk. “You’ve got to be the little doll in the middle and stay compartmentalized in order to move forward,” he says. He keeps sets of the dolls everywhere.

When talking about how doctors cope with the loss of their patients, Myron Cohen points to a set of Russian nesting dolls he keeps on his desk. “You’ve got to be the little doll in the middle and stay compartmentalized in order to move forward,” he says. He keeps sets of the dolls everywhere.

Jason Smith

The Little Doll in the Middle

At the UNC vs. Virginia basketball game on February 11, 2012, a man in a blue suit stood at half court and waved. He had given lectures to 7,000 people in Rome and 30,000 in Mexico City, but this was one of the most surreal moments of his life. “All I did was wave, but I was totally petrified,” Myron Cohen says. “I couldn’t sleep the night before.” You see, Cohen isn’t the usual person you’d expect to receive such treatment at a sporting event. Not a basketball star or coach. Not a war hero. He’s a scientist. Science magazine had just named Cohen’s research on HIV the 2011 Breakthrough of the Year. Here, in the Dean Smith Center, the crowd was giving him a standing ovation.

Science and medicine were never on Cohen’s radar until his sophomore year of college, when his best friend died of leukemia. “I went home for winter break, and my friend was in the hospital,” Cohen says. “He was unconscious when I arrived, and he died in a matter of days.”

Until then, Cohen had been mostly interested in communications and journalism. But the time Cohen spent beside his friend in the hospital started to make him feel like he was somehow meant to be a doctor. He thought that his intellectual curiosity, coupled with his ability to communicate with people and understand what was going on around him, might help him be a physician. “I have no idea what got into me,” he admits. “But here I am.”

Cohen attended medical school through an accelerated program and was still young when he finished his training. One time, performing a simple surgical procedure, he started to sweat so profusely that he thought it was raining. He told one of his mentors that he didn’t think he was cut out for surgery. But he soon realized that he had great teachers and mentors in the study of infectious disease, and he quickly became captivated by the subject. “It crosses specialties, it mixes many aspects of medicine, and there’s always something new,” he says. “I could see that you can do so many different things in this career.”

In 1980, Cohen and his wife, Gail Henderson—now the Chair of the Department of Social Medicine at UNC—were looking for a place to establish their careers and raise their family. They decided Chapel Hill was the place. “To be maximally successful you cannot move around,” Cohen says. “You have to decide what your goal is, build the infrastructure that you need for that goal, and stay put. My wife and I like our colleagues, we like the administration of the university, and we were allowed to do what we wanted to do. There was never a moment where somebody said you can’t do a certain thing.”

Jason Smith

Myron Cohen in his office in April 2012.

Click to read photo caption. Jason Smith

It’s easy to forget that when Cohen first came to UNC in 1980, HIV was unheard of. Towards the end of his first year at Carolina, Cohen treated a young man with hemophilia. The patient had a fever and swollen glands, but no tests could determine why. It wasn’t cancer or a bacterial infection. The hospital sent the patient’s samples for specialized testing, and when the results came back, Cohen and his colleagues realized the patient had HIV. “We had an emergency meeting,” he says, “and we talked about this as our first case of HIV, and said, ‘What are we going to do?’” By 1982, that young man had died, and the hospital’s HIV ward was full.

Hundreds of patients have since come through the clinic and, despite so many advances in treatment and patient care, loss has been inevitable. “These are very sick people; we don’t take care of well people,” Cohen says. “And it really affects us. I saw patients this December, and one of those patients died. When you think you could have done something a little bit differently with a different outcome, you never forget it. There is no lesson you can learn that makes it easier. Nor do I think there should be.”

He points to a set of Russian nesting dolls that sit on his desk. “You’ve got to be the little doll in the middle and stay compartmentalized in order to move forward,” he says. He keeps sets of the dolls everywhere.

Cohen’s initial research at UNC focused on gonorrhea. In 1987, he published a study on how quickly bacterial particles in vaginal secretions and semen could be reduced to noncontagion following antibiotic treatment. “As the tools became available, we extrapolated from our work in gonorrhea to start work on HIV,” Cohen says. “It’s the exact same study from 1987. I wish I had had a really good new idea, but I didn’t. The best idea came when I had a very young brain.”

The HIV study began in 1990 in Malawi as a part of a larger group of studies being carried out by the HIV Prevention Trials Network. Members of the research team gathered data to understand transmission of HIV. They then developed tests for use in the study. A graduate student examined the concentration of HIV in secretions, much like Cohen’s team had done with gonorrhea years earlier. After the team determined which drugs would work for the study, six pharmaceutical companies donated millions of dollars worth of drugs. The team passed all its data on to an oversight board.

When the oversight board said—much earlier than expected—that it had a recommendation, Cohen and his colleagues thought they had failed. “They didn’t tell us the recommendation,” he says. “They said, ‘We’re not going to tell you; we have to tell the NIH.’ We thought we had failed. People were crying in our group.”

The oversight board revealed that there had been a 96 percent reduction in transmission of HIV to uninfected partners following early treatment with antiretroviral drugs. And it recommended that the study continue while these initial promising results were made public. Twenty years’ worth of work all came down to one number in the end. “It’s the journey more than the result,” Cohen says. “What if the result had been 10%? It didn’t have to be 96%. But I still went on the same journey.” And it was this number that earned Cohen’s team, and the study, recognition as Science magazine’s 2011 Breakthrough of the Year.

Cohen was excited about the Science recognition, but he was even more pleased for his colleagues. “I’m not a chemist,” Cohen says. “It’s crazy to think this was one person. It’s not like I was working in a lab and poured a chemical and said, ‘Eureka! I made plastic.’” He remembers the day that he got to call the team members at the thirteen study sites across the globe to tell them the antiretroviral treatment had worked to prevent transmission. “That was the very best moment,” he says. “They generated the data, not me.”

Cohen’s work has already affected policy and given people hope. But how translatable is this initial study? And what does it mean for the long-term goals of prevention and cure?

“We demonstrated the potential,” he says. “We recognize huge limitations; therefore we embrace an attempt to do translation.” The study of 4,000 couples is still ongoing. And Cohen and his team will be a part of a second, broader trial of the antitretrovirals to try to prevent 1.2 million patients from transmitting HIV.

“We don’t stop,” Cohen says. “We move on as quickly as we can.”

UNC has four goals for HIV—better prevention, better care, better treatment, and a cure—and Cohen’s team is dedicated to all four. Today, Cohen says, the number-one barrier to reaching these goals is some combination of stigma and lack of knowledge of status. “The most important thing we can do with the tools that are now available,” he says, “is to reduce stigma and create an environment where people are comfortable being tested.”

Cohen saw the HIV epidemic start; does he believe he will see it end? He says the tools that could lead to an AIDS-free generation are in our hands. “If I get to work on this for another 20 years,” he says, “it doesn’t seem impossible that I will see the end.” At any rate, Cohen says, “it’s kind of a worthwhile life. It’s a life well-lived.”

UNC-Chapel Hill

Sarah Creed is a postdoctoral research associate in James Bear’s lab in the UNC Lineberger Comprehensive Cancer Center.

Myron S. Cohen is the J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology, and Epidemiology, and director of the Center for Infectious Diseases at UNC. Cohen is one of the leaders of the National Institute of Allergy and Infectious Diseases-sponsored HIV clinical trials group known as HIV Prevention Trials Network, a worldwide consortium of U.S. and international academic institutions and organizations conducting studies on HIV prevention. The study, “Prevention of HIV-1 Infection with Early Antiretroviral Therapy,” was published in the New England Journal of Medicine on August 11, 2011.

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